197. Electronic Medical Record (EMR) Solutions to Reduce Central Line Associated Bloodstream Infections (CLABSI) by Enhancing Documentation of Central Line Insertion Practices, Line Days, and Daily Line Necessity
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • 197 K Quan CLABSI poster FINAL SH (2).pdf (533.8 kB)
  • Background: National efforts to reduce CLABSI include monitoring of central venous catheter (CVC) insertion techniques and promoting line removal. However, high-compliance monitoring, including feedback of lapses in these activities, is difficult.

    Methods: We developed three EMR solutions to enhance documentation of CVC practices and decrease CLABSI risk. First, we developed electronic nursing documentation of individual CVCs. Daily e-flowsheets were modified to collect CVC insertion site/side, type, and site assessment. For new CVCs, inserter name and unit of insertion were also collected. Second, we created a highly efficient electronic procedure note that provided easily selected template language and required checkbox responses for Central Line Insertion Practices (CLIP) elements. Reports were generated to link new CVC insertion data from e-flowsheets with e-procedure notes. Missing e-procedure notes were reported to the CVC inserter (if provided) and unit-specific physician and nursing leadership for performance improvement. Third, we cascaded each CVC from the e-flowsheet into physician e-progress notes. The notes required primary physicians to assert the necessity for each provided CVC via checkbox daily documentation.


    Results:   These EMR solutions rapidly improved identification of CVCs by 38% (mean 2100 to 2900 line days per month) and provided a mechanism to distinguish lines that were present on admission, ongoing, or newly-placed. The e-procedure note with feedback loop for missing forms resulted in an increase in capture of CLIP elements from 46% to 80% of all lines placed within 6 months of launch. Use of nursing e-flowsheets to auto-populate physician e-progress notes and require daily evaluation of line necessity provided a mechanism for ensuring documentation which was previously non-existent.

    Conclusion: A targeted EMR feedback system built within electronic daily nursing and physician documentation streamlined workflow and increased compliance with evidenced-based processes for decreasing CLABSI risk.


    Kathleen A. Quan, RN, MSN, CIC1, Sarah M. Cousins, BS2, Darlene D. Porter, BSN, RN, PHN3, Phil Lemons3, Margaret O'brien, RN, BSN4, Scott Rudkin, MD3, Brian Lambertson3, Dennis Hoang3, Amish A. Dangodara, MD5, Amy Krista3, Janette Jimenez-Rivera, RN MSN CCRN4 and Susan S. Huang, MD, MPH, FIDSA2, (1)Epidemiology and Infection Prevention Program, University of California Irvine Health, Orange, CA, (2)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, (3)Health Affairs Information Services, UC Irvine Health, Orange, CA, (4)Nursing Informatics, UC Irvine Health, Orange, CA, (5)UC Irvine Hospitalist Program Informatics, Orange, CA


    K. A. Quan, None

    S. M. Cousins, None

    D. D. Porter, None

    P. Lemons, None

    M. O'brien, None

    S. Rudkin, None

    B. Lambertson, None

    D. Hoang, None

    A. A. Dangodara, None

    A. Krista, None

    J. Jimenez-Rivera, None

    S. S. Huang, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.